Motivating for change – the place of the working alliance

Over the past three days Nev Trainor and myself have had the pleasure of updating Practice Leaders from the New Zealand Community Probation Service on the latest thinking around motivational interviewing. With the new edition of Motivational Interviewing (3rd edition) by Bill Miller and Stephen Rollnick due out soon, this was an opportune time to revisit the core skill set for engaging where there are high levels of resistance to change and where probation officers can easily fall into the trap of being more responsible for managing risk than the offender themselves. What sits below in terms of building a working alliance of course has a much wider application than a purely Corrections setting.

We shared with the group the key ideas behind what we considered constituted the working alliance (sometimes referred to as the therapeutic alliance) and how this is often rendered invisible or not made explicit. The working alliance is constituted by three main factors: bond between the probation officer and offender, reaching agreement on the goals or purpose of the engagement, and agreement on the various tasks that need to take place in order to meet the goals/purpose. Before unpacking each of these it is my contention that not enough attention is given to the bond aspect of the working alliance. Our job is to attend to this more fully. The image below indicates that it is often submerged in many instances and needs to be brought to the surface through explicit conversations.

Bond: In line with MI consistent practice and many other approaches, the bond is of critical importance. Trust is the central ingredient required to develop bond in terms of a working alliance. Trust, as we all know, is often hard to build and easy to lose. When we work with people whose experience of life is often based upon mistrust or where attributes of hostile intent are present, we need to stand out from the crowd.  Sometimes consistency is all we need as the first step in the process of building trust. A question I often ponder early on with clients is, “On a scale of 1 – 100 how honest can you be with me about what goes on in your life?”. “What do you require from me to make it easier to do the work we need to do together?” Trust is about taking the risk to be vulnerable, to expose our inner worlds to others, to be prepared to be transparent with ourselves and others.

In essence this is far more than purely engagement and is the positioning of the worker in relation to the person sitting in front of them. This is where the spirit of MI becomes most evident:

    • Partnership (collaboration). Finding the ability to sit together and gaze outwards toward the issue that is on the table.
    • Acceptance of the person’s rights to decide (autonomy). They may decide in a direction that we view as not helpful or creating risk to others. In this case there are consequences for taking that position and as workers with a responsibility for the wider safety of the community, action is inevitable.
    • Compassion. In my view this is the basis of empathy and if people are not appreciated for their humanity, then discord will appear within the relationship. The mantra I remind myself to consider in relation to others is, “Understand my world and my experience and you will understand my behaviour”.
    • Evocation. Inviting the person to argue for change rather than being told is the essence of building intrinsic motivation, as we all know.

Goals/Purpose. In New Zealand we call this the kaupapa (purpose) of working together. Getting agreement around what to work on becomes the interesting area for Probation Officers. Their purpose is to maintain sentence integrity through compliance with sentence conditions, reducing the likelihood of reoffending, and minimising the risk of harm to others. The key skill, where there are explicit external goals, is around how to join these goals with the person’s own goals. This then shifts extrinsic to intrinsic and we all know which one is more enduring.

Task: Task focus cannot occur until bond and goals are established. The many small tasks to meet the goals (so that the person can reduce the influence of the problem behaviour) need to be achievable and realistic. We know that probation officers are often working with people who have low confidence in their ability to exert agency (the ability to influence their own world). This is where the skill of noticing and affirming any movement towards change becomes all the more important. Even affirming the willingness to sit in the room and have a conversation in my view takes great courage and strength.

 This is where my thinking has got to around these issues. Love to hear yours.

 

 

Published on Friday, June 15th, 2012, under Learning & development, Motivational Interviewing

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